The Children’s Advocacy Center of Southeastern Indiana has more work to do after an allegation of abuse than just conducting a forensic interview. When law enforcement or a Department of Child Services caseworker refers a child to us, our first major step is the interview — a series of non-leading questions that helps prosecutors and investigators understand what happened to a child, according to their answers. But after that, if abuse did happen, medical and health issues must be addressed for the child and often the non-offending family members.
CACSEI has begun partnering with Dr. Robert Shapiro, Division Director from the Mayerson Center for Safe and Healthy Children at Cincinnati Children’s Hospital Medical Center.
“It’s too early to know, but I have been struck by the need for more mental health and substance abuse treatment,” says Dr.Shapiro about early case reviews from southeastern Indiana. “One of the leading causes of mental health disorder is sexual abuse. And the problems that patients and families encounter [around southeast Indiana] may not be the same as what we see in Cincinnati.”
Dr. Shapiro’s medical team is currently investigating the needs of patients and families in the area, which medical providers are available, what type of services they can provide, and what is missing.
Many areas, not just southeast Indiana, lack physicians and medical professionals that we commonly refer to as “trauma-informed”, meaning they have skills and experience in how to handle patients who have trauma experiences based on evidence-based or evidence-informed practices. “This moves beyond the scope of a family physician and a physical exam,” says CACSEI Executive Director Stephanie Back.
“We do know through well-documented studies, some of which we conducted in Cincinnati, that many physicians lack the training to complete an evaluation for sexual abuse and recognize normal versus traumatic findings on examination,” says Dr. Shapiro. “
“One of the parts of the medical evaluation is an exam by someone who is trained in how to inform the family and the child victim of their health status and findings,” says Dr. Shapiro, noting that children may not even be fully aware of what all has happened to them. That lack of understanding can make exams challenging.
“The other thing we do differently is we may find a need to screen for sexually transmitted infections. In children that is not something easily done because the tests used to screen for STI’s have mostly been tested and used on adults. Interpreting those results for a pediatric patient requires extra analysis and caution,” says Dr. Shapiro.
In July 2019, Dr. Shapiro met with CACSEI staff, DCS caseworkers, law enforcement, and other partners to talk about what work might be needed and what they can expect from him. Currently, CACSEI is referring three to four cases per month to Cincinnati Children’s Batesville regional location. CACSEI sees approximately five to six hundred cases a year.